Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Monday, December 6, 2010

A Lookback at 2010

Every Summer I work with my governance committees and IS staff to develop operating plans for the year ahead. Every Winter, I think about the new issues and challenges that keep me awake at night and review the progress on the previous year.

BIDMC
Intranet - Our new intranet went live with all expected features and technologies. As part of the project, we introduced a web application firewall and reverse proxy capability. Mastering any new technology and ensuring it is configured for disaster recovery and high reliability takes training and resources. We are not shutting off our old portal, which at this point is just a fallback and is not used much, until early 2011 to allow time for hardening all our newly introduced technologies.

Enterprise Image Management - We migrated all cardiology images to our new GE Enterprise Archive 4.0/EMC Atmos Enterprise Image Archive. Vendor neutral archives are definitely becoming more mainstream, but they are still a challenge for RIS/PACS vendors. I expect support for these archives to be built into imaging products in 2011.

EHR rollouts - By January all 1700 clinicians in our physician's organization will have a certified EHR in place. The major challenges have been workflow redesign, change management, and communication.

Business Intelligence - After years of experimentation and investigation, we settled on a suite of new functionality using Microsoft SQL Server 2011 Reporting and Analysis services to meet our business intelligence needs.

Interoperability - Our Meaningful Use related interoperability efforts (provider to provider summary exchange, public health exchange, and quality data warehousing) will all be live by the end of 2010. The standards for content and vocabulary were taken from the Standards Final Rule. The standards used for transport were SOAP 1.2 using XDR. We are seeing convergence of vendor approaches to healthcare information exchange, which is making our integration task easier.

HMS
High Performance Computing - In November we expanded our High Performance Computing facility from 1000 cores to 2000 cores. By January it will be at 5000 cores. By March it will be at 6000 cores, incorporating graphics processing unit support and InfiniBand connections to storage. The major challenge was more power and cooling support.

Storage - Our enterprise storage now includes over 1 petabyte of replicated storage at 2 different service levels - high performance and standard performance. The challenge has been developing an NIH compliant chargeback model to sustain the growth of our storage infrastructure and staff.

Content Management - we experimented with content management but the project to migrate all externally facing content to a single infrastructure with a common navigation experience and search was not funded in the past year. Hopefully it will be in 2011.

Social Networking for Research - We completed several releases of our social networking platform for research, open sourced it, and implemented it at 60 Universities throughout the world. Profiles has been a great success story.

NEHEN/State Healthcare Information Exchange
At NEHEN, we added more transactions and more trading partners, obtained additional funding to accelerate our work, and went live with all the capabilities needed to support meaningful use. At the State level, our trajectory to complete a governance design, prepare for procurement, and plan for business operations has been positive.

Federal
Over the past year, the Standards and Certification Final rule was published, work on transport standards moved forward, and multiple efforts to accelerate implementation and adoption are in process.

Personal
My daughter applied to college (early decision results are available in 10 days).

My parents are back home after their healthcare experiences in November.

My wife and I are spending even more time together walking, talking, and enjoying nature.

My commitment to the outdoors has included more kayaking, skiing, hiking, biking, and mountaineering experiences

Thus, despite the tyranny of the urgent, substantial new work, a continually changing healthcare environment and new compliance/regulations, 2010 was a good year. In many ways, I'm surprised that the 2010 things that kept me up at night are all on track. Along the way, 2010 was a roller coaster. But due to the hard work of hundreds of people, all will be well.

2 comments:

This is a great overview of your year - thanks for sharing. It is especially heartening to hear that the vendors you have dealt with have begun to developed a more coordinated approach to interoperability solutions. And your thoughts have given me a few ideas for the upcoming CIO profile series we hope to launch in our Healthcare Intelligence Hub newsletter and LinkedIn group next year.